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APPLICATION FOR SANITATION PERMIT Permit No.4. ___!_- - -/--.-- (Complete in Duplicate) ' fl Date Issued ___ Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. / JOB ADDRESS AND LOC TION---- '- --- -L_ 3�-------fes--`----v---- --- ----------------------------- '�'_—`-T- --- Owner's Name. -------��rr��{` �� '��---------------' ---------------- -------------------------------------------- Phone--------------------------------•--- Address..... '..._._ '.l�'�a:... --- ------- ----- ----- - ------------------- ------------................ ep Contractor's Name---��'____ _------•---------------------------------------------•--•-------•--•---•--------•-----------•----••- Installation will serve: Residence U f, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _4__ Number of bedrooms ./----- Number of baths __I____ Lot size ------------------------------------------------------- Water _ ------_____'________________________________Water Supply: Public system ❑ Community system ❑ Private R �pth to Water Table.3fl a_ ft. Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) D�sfance from Septic._ Tank: No. of compartme tsr_Wim:. --- --Size---- foundation-Liquid d�pth...y+-'S— I.__.._-_Capacity__�"� �� i Disposal Field: Distance from nearest well_ d_a.._.._Distance from foundation----/6_.___....Distance to nearest lot line_____- Number of lines-------- --- Length of each line______°____- ----_----.Width of trench._Z-_` _'__-__-_______________� {� Type of filter material__ ��f - ________________________ Seepage Pit: Distance to nearest well__®'0__--___Distance omfoundation____c75P�_`._.Distance to nearest lot line_.Z_ ____ " -- Number of pits___.. . ---Lining material__________________.....Size: Diameter_&Ste'_______.____De tn__,Z4D__.______-_____._____ Cesspool• Distance from nearest welL________________Distance from foundation--------------------Lining material_-_____..__.--.____-.-______-____..__. ❑ Size: Diameter------ ----------- -------------------Depth--------------------•--•----------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well----------_------___-----------------------------Distance from nearest building-------------_--------------------------- El ----_-_-------------------❑ Distance to nearest lot line--------------------------------------------- - ----------------------------------------------- -------------------------------------- a Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- -------------------------------•------------- ---------------••---=--------•-••-----------•--------------------.-•----------•-•-------------------------------------------------------------------•--------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ---------- --- ( '- od/, r Contractor) ----- --- -- ---- ----- --------------------------------------------- -------- ---- Title BY= l 1-- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEP RTMENT USE ONLY APPLICATION ACCEPTED BY --- - -- ---------------------------------------------- DATE----------- REVIEWEDBY----- ------------------------------- --------------------------------- ---------------------------------------------------- DATE-----------------------------------•----------------------- BUILDINGPERMIT ISSUED---------------------------------- --------------------------------._ DATE----- -------------•---------------------------------------- Alterations and/or recommendations:-------------------- -----T---- ------ -- ---------------------------------------------------------------------------------------------•----•-----••------- ------------------------------------------------------------------- ------------ ---------------------------------------------------- ------------------------------------------------------------ FINAL INSPECTION BY------ -------- ---------------------------------•----- Date..----------/77Z- 3---- - ------.----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Norah "C' Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 145446 ATWOLM 12-54